Comparison of efficacy between video-assisted thoracoscopic surgery and thoracotomy in children with mediastinal tumors: 6-year experience

Abstract

Background: Video-assisted thoracic surgery (VATS) has been increasingly used in pediatric patients. We evaluated the outcomes of VATS and thoracotomy for pediatric mediastinal tumors. Methods: A total of 137 patients who underwent surgery for mediastinal tumors at our department from March 2012 to September 2018 were recruited in this retrospective study. Forty-three patients were treated by VATS and ninety-four underwent thoracotomy (two patients who underwent open surgery were excluded from the study because they were lost to follow-up). Data including demographic information, tumor characteristics, operative time, conversion of surgery, blood transfusion, postoperative hospital stay, mortality and recurrence were collected and compared between the two groups.Results: No significant difference was found in gender, age, weight and tumor distribution between the two groups. The number of patients with malignant tumors who underwent thoracotomy was significantly higher than those who received VATS (78.0% vs. 22.0%, P=0.04). Patients received thoracotomy had significantly larger mean tumor diameter than those who underwent VATS (7.6±3.8 vs. 4.4±1.7 cm, P<0.001).The intraoperative transfusion rate in the thoracotomy group was significantly higher than that in the VATS group (67.4% vs. 14.0%, P<0.001), so was the amount of blood transfusion (148.1±150.7 vs. 23.3±61.1 mL, P<0.001). The VATS group had significantly shorter operative time as compared with the thoracotomy group (94.3±40.9 vs. 133.5±72.1 min, P=0.002). During follow-up, local recurrence was found in 8 (8.7%) patients who underwent thoracotomy, and no significant difference was found in local recurrence rate between the two groups. Four patients who underwent thoracotomy died, and no significant difference was found in mortality between two groups.Conclusions: Due to less blood transfusion, shorter operative time and postoperative hospital stay, VATS is a safer surgical treatment for pediatric mediastinal tumors than thoracotomy.

The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature

“…Median LHS was 5 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In two cases, we observed intraoperative bleeding (4.7%): one biopsy of a germ cell tumor managed thoracoscopically and one lung resection for nephroblastoma metastasis which required conversion to open surgery.…”

“…A review of the most recent literature on the topic was performed. From a total of 229 articles, seven were included in the review according to the inclusion criteria (Table 2) (9)(10)(11)(12)(13)(14)(15).…”

“…Morbidity, mortality, and length of hospitalization are lower when compared to open surgery (19). Success rate of thoracoscopic-assisted biopsies have been reported in literature ranging from to 100% for both histological and/or bacteriological diagnosis (12,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Nonetheless, different techniques have been proposed to further enhance the accuracy of MIS, such as intraoperative ultrasound localization (both trans-pleural and endoscopic) (29), CT-guided needle localization with methylene blue staining, or micro-coil application (15,30,31).…”

Tubeless video-assisted thoracoscopic surgery in mediastinal tumor resection

“…Video-assisted thoracic surgery, as a minimally invasive technology, has been shown to be secure in the treatment of mediastinal tumors. Due to the advantages of smaller incision, shorter hospital stays, less postoperative pain and bleeding, this method has been widely accepted in the world (12). With the development of VATS techniques and anesthesia control, tubeless anesthesia with spontaneous ventilation has also gotten better development and application in VATS.…”

Comparison of different surgical approaches for anterior mediastinal tumor

“…Subxiphoid and intercostal approaches are the main approaches for anterior mediastinal tumor resection under thoracoscopic in clinical practice, which can reduce postoperative pain and achieve a good therapeutic effect with high safety (5)(6)(7). The subxiphoid approach avoids chronic postoperative incisional pain and chest cavities.…”